Provider Demographics
NPI:1376151621
Name:REDFEARN, KIARA DANIELLE
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:DANIELLE
Last Name:REDFEARN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 HALLEY PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2330
Mailing Address - Country:US
Mailing Address - Phone:202-280-3712
Mailing Address - Fax:
Practice Address - Street 1:27 HALLEY PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2330
Practice Address - Country:US
Practice Address - Phone:202-280-3712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician